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702 kidney


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702 kidney

  1. 1. The Urinary System• Functions of the urinary system• Anatomy of the kidney• Urine formation – glomerular filtration – tubular reabsorption – water conservation• Urine and renal function tests• Urine storage and elimination
  2. 2. Urinary System• Two kidneys• Two ureters• Urethra
  3. 3. Kidney Functions• Filters blood plasma, eliminates waste, returns useful chemicals to blood• Regulates blood volume and pressure• Regulates osmolarity of body fluids• Secretes renin, activates angiotensin, aldosterone – controls BP, electrolyte balance• Secretes erythropoietin, controls RBC count• Regulates PCO2 and acid base balance• Detoxifies free radicals and drugs
  4. 4. Nitrogenous Wastes• Urea – proteins→amino acids →NH2 removed →forms ammonia, liver converts to urea• Uric acid – nucleic acid catabolism• Creatinine – creatinine phosphate catabolism• Renal failure – azotemia: nitrogenous wastes in blood – uremia: toxic effects as wastes accumulate
  5. 5. Excretion• Separation of wastes from body fluids and eliminating them – respiratory system: CO2 – integumentary system: water, salts, lactic acid, urea – digestive system: water, salts, CO2, lipids, bile pigments, cholesterol – urinary system: many metabolic wastes, toxins, drugs, hormones, salts, H+ and water
  6. 6. Anatomy of Kidney• Position, weight and size – retroperitoneal about 160 g each – about size of a bar of soap (12x6x3 cm)• Shape – lateral surface - convex; medial - concave• CT coverings – renal fascia: binds to abdominal wall – adipose capsule: cushions kidney – renal capsule: encloses kidney like cellophane wrap
  7. 7. Anatomy of Kidney• Renal cortex: outer 1 cm• Renal medulla: renal columns, pyramids - papilla• Lobe of kidney: pyramid and it’s overlying cortex
  8. 8. Lobe of Kidney
  9. 9. Kidney: Frontal Section• Minor calyx: cup over papilla collects urine
  10. 10. Path of Blood Through Kidney• Renal artery → interlobar arteries (up renal columns, between lobes) → arcuate arteries (over pyramids) → interlobular arteries (up into cortex) → afferent arterioles → glomerulus (cluster of capillaries) → efferent arterioles (near medulla → vasa recta) → peritubular capillaries → interlobular veins → arcuate veins → interlobar veins• Renal vein
  11. 11. Blood Supply Diagram
  12. 12. Renal Corpuscle Glomerular filtrate collects in capsular space, flows into renal tubule
  13. 13. Renal (Uriniferous) Tubule• Proximal convoluted tubule (PCT) – longest, most coiled, simple cuboidal with brush border• Nephron loop - U shaped; descending + ascending limbs – thick segment (simple cuboidal) initial part of descending limb and part or all of ascending limb, active transport of salts – thin segment (simple squamous) very water permeable• Distal convoluted tubule (DCT) – cuboidal, minimal microvilli
  14. 14. Renal (Uriniferous) Tubule 2• Juxtaglomerular apparatus: DCT, afferent, efferent arterioles• Collecting duct: several DCT’s join• Flow of glomerular filtrate: – glomerular capsule → PCT → nephron loop → DCT → collecting duct → papillary duct → minor calyx → major calyx → renal pelvis → ureter → urinary bladder → urethra
  15. 15. Nephron Diagram • Peritubular capillaries shown only on right
  16. 16. Nephrons• True proportions of nephron loops to convoluted tubules shown• Cortical nephrons (85%) – short nephron loops – efferent arterioles branch off peritubular capillaries• Juxtamedullary nephrons (15%) – very long nephron loops, maintain salt gradient, helps conserve water – efferent arterioles branch off vasa recta, blood supply for medulla
  17. 17. Urine Formation Preview
  18. 18. Filtration Membrane Diagram
  19. 19. Filtration Membrane • Fenestrated endothelium – 70-90nm pores exclude blood cells • Basement membrane – proteoglycan gel, negative charge excludes molecules > 8nm – blood plasma 7% protein, glomerular filtrate 0.03% • Filtration slits – podocyte arms have pedicels with negatively charged filtration slits, allow particles < 3nm to pass
  20. 20. Filtration Pressure
  21. 21. Glomerular Filtration Rate (GFR)• Filtrate formed per minute• Filtration coefficient (Kf) depends on permeability and surface area of filtration barrier• GFR = NFP x Kf ≈ 125 ml/min or 180 L/day• 99% of filtrate reabsorbed, 1 to 2 L urine excreted
  22. 22. Effects of GFR Abnormalities∀ ↑GFR, urine output rises → dehydration, electrolyte depletion∀ ↓GFR → wastes reabsorbed (azotemia possible)• GFR controlled by adjusting glomerular blood pressure – Auto regulation – sympathetic control – hormonal mechanism: renin and angiotensin
  23. 23. Juxtaglomerular Apparatus - Vaso motion - monitor salinity
  24. 24. Renal Autoregulation of GFR ∀ ↑ BP → constrict afferent arteriole, dilate efferent • ↓ BP → dilate afferent arteriole, constrict efferent • Stable for BP range of 80 to 170 mmHg (systolic) • Cannot compensate for extreme BP
  25. 25. Negative Feedback Control of GFR
  26. 26. Sympathetic Control of GFR• Strenuous exercise or acute conditions (circulatory shock) stimulate afferent arterioles to constrict∀ ↓ GFR and urine production, redirecting blood flow to heart, brain and skeletal muscles
  27. 27. Hormonal Control of GFR -efferent arterioles
  28. 28. Effects of Angiotensin II
  29. 29. Tubular Reabsorption and Secretion
  30. 30. Peritubular Capillaries• Blood has unusually high COP here, and BHP is only 8 mm Hg (or lower when constricted by angiotensin II); this favors reabsorption• Water absorbed by osmosis and carries other solutes with it (solvent drag)
  31. 31. Proximal Convoluted Tubules (PCT)• Reabsorbs 65% of GF to peritubular capillaries• Great length, prominent microvilli and abundant mitochondria for active transport• Reabsorbs greater variety of chemicals than other parts of nephron – transcellular route - through epithelial cells of PCT – paracellular route - between epithelial cells of PCT• Transport maximum: when transport proteins of plasma membrane are saturated; glucose > 220 mg/dL remains in urine (glycosuria)
  32. 32. Tubular Secretion of PCT and Nephron Loop• Waste removal – urea, uric acid, bile salts, ammonia, catecholamines, many drugs• Acid-base balance – secretion of hydrogen and bicarbonate ions regulates pH of body fluids• Primary function of nephron loop – water conservation, also involved in electrolyte reabsorption
  33. 33. DCT and Collecting Duct• Effect of aldosterone ↓ BP causes angiotensin II formation – angiotensin II stimulates adrenal cortex – adrenal cortex secretes aldosterone – aldosterone promotes Na+ reabsorption – Na+ reabsorption promotes water reabsorption – water reabsorption ↓ urine volume – BP drops less rapidly
  34. 34. DCT and Collecting Duct 2• Effect of atrial natriuretic factor (ANF) ↑ BP stimulates right atrium – atrium secretes ANF – ANF promotes Na+ and water excretion – BP drops• Effect of ADH – dehydration stimulates hypothalamus – hypothalamus stimulates posterior pituitary – posterior pituitary releases ADH – ADH ↑ water reabsorption – urine volume ↓
  35. 35. Collecting Duct Concentrates Urine • Osmolarity 4x as high deep in medulla • Medullary portion of CD is permeable to water but not to NaCl
  36. 36. Control of Water Loss• Producing hypotonic urine – NaCl reabsorbed by cortical CD – water remains in urine• Producing hypertonic urine – GFR drops – tubular reabsorption ↑ – less NaCl remains in CD – ADH ↑ CD’s water permeability – more water is reabsorbed – urine is more concentrated
  37. 37. Countercurrent Multiplier• Recaptures NaCl and returns it to renal medulla• Descending limb – reabsorbs water but not salt – concentrates tubular fluid• Ascending limb – reabsorbs Na+, K+, and Cl- – maintains high osmolarity of renal medulla – impermeable to water – tubular fluid becomes hypotonic• Recycling of urea: collecting duct-medulla – urea accounts for 40% of high osmolarity of medulla
  38. 38. Countercurrent Multiplierof Nephron Loop Diagram
  39. 39. Countercurrent Exchange System• Formed by vasa recta – provide blood supply to medulla – do not remove NaCl from medulla• Descending capillaries – water diffuses out of blood – NaCl diffuses into blood• Ascending capillaries – water diffuses into blood – NaCl diffuses out of blood
  40. 40. Maintenance of Osmolarity in Renal Medulla
  41. 41. Summary of TubularReabsorption and Secretion
  42. 42. Composition and Properties of Urine• Appearance – almost colorless to deep amber; yellow color due to urochrome, from breakdown of hemoglobin (RBC’s)• Odor - as it stands bacteria degrade urea to ammonia• Specific gravity – density of urine ranges from 1.000 -1.035• Osmolarity - (blood - 300 mOsm/L) ranges from 50 mOsm/L to 1,200 mOsm/L in dehydrated person• pH - range: 4.5 - 8.2, usually 6.0• Chemical composition: 95% water, 5% solutes – urea, NaCl, KCl, creatinine, uric acid
  43. 43. Urine Volume• Normal volume - 1 to 2 L/day• Polyuria > 2L/day• Oliguria < 500 mL/day• Anuria - 0 to 100 mL
  44. 44. Diuretics• Effects ↑ urine output ↓ blood volume• Uses – hypertension and congestive heart failure• Mechanisms of action ↑ GFR ↓ tubular reabsorption
  45. 45. Renal Function Tests• Renal clearance: volume of blood plasma cleared of a waste in 1 minute• Determine renal clearance (C) by assessing blood and urine samples: C = UV/P – U (waste concentration in urine) – V (rate of urine output) – P (waste concentration in plasma)• Determine GFR: inulin is neither reabsorbed or secreted so for this solute GFR = renal clearance GFR = UV/P